高龄经产妇妊娠管理临床护理路径的构建

Construction of the clinical nursing pathway for pregnant management of elderly multipara

目的构建适于高龄经产妇妊娠管理的临床护理路径。方法在病历分析、文献回顾的基础上,构建"高龄经产妇妊娠管理临床护理路径草案";选择省内10名从事妇产科临床医疗或护理的专家,采用德尔菲法(Delphi)对该草案进行两轮专家函询,最终形成"高龄经产妇妊娠管理临床护理路径"。结果两轮Delphi法专家的回复率均为100.00%,两轮函询提出建议的专家分别为60.00%(6/10)和20.00%(2/10);两轮专家对函询条目的熟悉程度系数均为0.90,判断依据系数均为0.80,权威系数均为0.85;两轮函询条目的重要性均数和标准差分别为2.60~4.05分(标准差0.34~0.94)和3.91~4.13分(标准差0.26~0.60)。两轮函询专家的协调系数(W)分别是0.441、0.592,均P<0.001,差异有统计学意义。"高龄经产妇妊娠管理临床护理路径"分为以时间为横轴的"确认妊娠至13+6周、孕14周至27+6周、孕28周至分娩"3个阶段,纵轴为4个模块(包括"病史收集、体格检查、其他检查、护理措施")共74个条目。结论本研究构建了"高龄经产妇妊娠管理的临床护理路径"。经统计分析结果可靠,专家对各条目的熟悉程度、权威程度、协调程度及集中程度均较高,有利于规范高龄经产妇妊娠管理,提高临床护理质量。

Objective To establish a clinical nursing pathway for elderly parturients.Methods The clinical nursing pathway draft for elderly parturients were designed though the method of case analysis and literature review.Delphi method was used by 10 experts engaged in clinical medical or nursing with 2 rounds.Results The recovery rates of the two Delphi method were 100%,the experts who put forward the proposal on the 2 rounds of expert conclusion were 60.00%（6/10） and 20.00%（2/10） respectively.The expert＇s familiarity with the correspondence is 0.90,the coefficient of judgment is 0.80 and the coefficient of authority is 0.85.The mean value and standard deviation of the 2 rounds of correspondence were 3.60 ~5.05（standard deviation 0.34 ~0.94） and 3.91 ~4.13（standard deviation 0.26 ~0.60）respectively.The coordination coefficients of the 2 rounds of experts consultation were 0.441 and 0.592（all P〈0.001）.The clinical nursing pathway for elderly parturients with pregnancy management were three stages：confirmed pregnancy to 13＋6 weeks,14 weeks to 27＋6 days pregnant and 28 weeks pregnant to childbirth,including a total of 74 projects for 4 modules such as medical history collection,physical examination,clinical laboratory and other examination and nursing measures.Conclusions The practicable clinical nursing pathway for elderly parturients was constructed because its high degree of familiarity,authority,coordination and concentration.The statistical analysis results are reliable,it is beneficial to standardize the pregnancy management for elderly parturients and improve the quality of clinical nursing.